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{ . Cont'd from pg 2 . Exhlblt ` �B Application Evaluation Review Sheet Applicant Name : Applicant #417 ; Graves Brothers Company Address : P . O . Box 700277 , Wabasso , FL 32970 Tract Number(s) : Marsh Grove Field Number(s) : 80 & 84 Date . July 9 , 2004 Land Use/Field : Acres : Micro4rrigated Citrus Grove 140 Best Management Practices Applied For: Install 2 FBR H2o Control Structures . Total BMP Costs: 75% Cost Share: Div By Total Eval Points: = Applicants Score: A ppiicant Cost: $ 159400 $11 , 550 50 231 . 00 $3 , 850 r sa A777777 I n ) '777,77 ", *7 7114 Id ( gnatur ) /batq( (Checked By) D e: � % CD Board Approval Date (Applicant Signature) Dat Privacy Act Statement: The following statements are made in accordance with the Privacy Act of 1974 (5U .S.C . 522a) . The authorities for requesting the information to be applied on this form are: 16 U . S.C. 590a-f (Soil and Water Conve ion); 16U .S.C . 3801 et seq. (Food Security Acto of 1985, as ammended) , and the regulation promulgated theruder. The inf ation requested is necessary for the evaluation of an application , development and implementation of a conservation plan as the basis for satisfying program eligibility and compliance requirements, and for providing technical education , or financial assist- ance under the previously mentioned authorities. Furnishing this information is voluntary; however, failure to fumish correct, complete information will result in the withholding or withdrawal of such technical , educational, or financial assistance. This information may be fumished to other USDA agencies, the Internal Revenue Service, the Department of Justice, or thi other State or Federal law enforcement agencies, or in response to orders of a court, magistrate, or administrative tribunal. I RSWCD Page 3 (10-26-01 )